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Student Evaluation Application

  • The pricing of the Medal Test Examinations is $12.00 per dance.
  • Make application and payment at least three weeks prior to the Evaluations.
  • It is the Studio’s responsibility to pay for the Examiner’s travel and meal expenses.


Medal Tests


Please indicate if Candidate is Junior  JR (16 and under) or Adult AD  (17 and over) 

Indicate International Ballroom or Latin, American Style, Smooth or  Rhythm in these columns BA/ LA/ SM/ RM
• Level of Test – Pre- Bronze (PB ), Full Pre-Bronze (FPB), Bronze (B) ,Full Bronze (FB) ,Silver (S) , Full Silver (FS) Gold (G) Full Gold (FG) Gold Star( GS), Gold Bar (GB) or Supreme Award  (SA) 
Number of Dances – Indicate Number of Dances to be presented in each


Given NameLast NameJR/ADBA LA SMRMLevel of ExamNumber of Dances